Ketogenic Diet - detailed information

Ketogenic Diet

What is the Ketogenic Diet and how does it work?

The Ketogenic Diet is a strict low carb, high fat diet on which you eat adequate protein. It lets the body feel as if it’s starving. In the Ketogenic Diet the body doesn’t get its energy from body fat, like it would do if it were really starving, but from the fat in food. This diet is mainly used as a form of therapy for children with epilepsy, glucose transport problems and a lack of Pyruvate Dehydrogenase. The Ketogenic Diet has to be tailored to an individual’s needs and carried out under the strict supervision of a doctor.

Only about 50% of proteins can be broken down during the metabolic process, as can about 10% of fats (mainly glycerine) like the different carbohydrates that are broken down into glucose to keep the blood sugar levels steady and above all to supply the brain with energy. When the body is in starvation mode it reaches for the stored glycogen (stored carbohydrates and changes into metabolic starvation mode. This means that fatty acids in the liver are broken down into keton bodies, which are used to cover the energy needs of the brain, which otherwise uses glucose as a source of energy, and they can do this job very efficiently.

The Ketogenic Diet can be considered for patients with epilepsy, who have not previously been helped by taking more than two anti seizure medicines or who are not suited to epilepsy surgery, as well as for patients with a GLUT 1 deficiency or a PDH deficiency. The ketogenic diet can be used to treat different kinds of attacks, epilepsy causes in children up to the teenage years. Although, it seems that it is more difficult for the diet to be effective between the ages of eight and twelve. The ketogenic diet can be used for babies under one just as it can for children in their first year. Positive results have come from the treatment of Rett Syndrome, Landau Kleffner Syndrome and Ohtahara Syndrome.

The calorie intake (30 – 80 kcal/kg depending on age and energy used) and the amount of protein needed (0.7 – 2g /kg depending on age) are calculated on a Ketogenic Diet. Then the so called Ketogenic Ratio, typically 3 – 4.5 : 1, is calculated. The Ketogenic Ratio calculates the weight ratio of fat to carbohydrates and protein. For example, a Ketogenic Ratio of 4:1 means that the food has to consist of 80% fat. The remaining 20% must contain enough protein in the diet.

Only a minimum amount of carbohydrates can be consumed to ensure that an effective state of ketosis is reached on the ketogenic diet. A ketosis as a result of a randomly induced lack of carbohydrate can be rectified by an intake of small amounts of carbohydrates, if on a ketogenic diet, in a short period of time. This can lead to an increased risk of attacks. This strict diet regime needs to be monitored by a professional who knows about the ketogenic diet. There also has to be a close working relationship between the patient on the ketogenic diet, the person taking care of them, the treatment team and those around them, like friends, family and colleagues.

The prescription for a ketogenic diet has to be reissued by a doctor, once it’s over, and it then has to be changed according to the results of the previous diet. The urine and/or blood ketosis checks, which are similar to blood sugar level checks for diabetics, have to be carried out properly.

The success of a ketogenic diet should be seen by an improvement of symptoms after eight and twelve weeks at the latest. In real special cases positive results can be seen after a few days. A rough estimate is that 10% of patients, who are on a ketogenic diet, will stop getting attacks, a further 15% will have a 90% reduction in attacks and 25% of the patients will have about half as many attacks. So, about a 50% reduction in attacks should be reached.

Some people’s epilepsy will get worse. If there haven’t been any positive results within the first three months then it is general advice to stop the diet.

If there have been positive results, then it is usual to follow the ketogenic diet for two years more.

Side effects of the ketogenic diet are mostly digestive problems and problems with bowel movements. These can be helped by changing the amount of fat in the diet or by examining other causes. In addition, sometimes patients get extremely tired, especially in the first two weeks as the metabolism changes, and usually after this time the patients feel more awake. There are also the following possible side effects include loss of appetite or feeling hungry and the psychological problems that go with these too, which should not be underestimated as these may affect the patient’s optimism, will power and commitment and weight loss or weight gain can also occur, although the diet should be tailored to the individual.

Rare or very rare side effects include:

Increase of infections

Breakdown of platelet functions leading to bleeding

Hypocalcemia

Heart rhythm problems

Every now and then the following side effects occur:

Kidney stones may form, but this can be tested for by a urine test

Unknown, rare causes of metabolic disorders, especially ketolysis, ketogenesis, problems with the breaking down of fats or carnitine deficiency syndrome, etc, may appear at the start of a ketogenic diet. These may appear suddenly and could possibly be life threatening, and that’s why a medical diagnoistic and anamnesis, as well as good (clinical) supervision is necessary at the beginning of a ketogenic diet. But, in general the side effects are less than those of a very strong anti seizure therapy.

After Brom (1857) and Phenobarbital (1910) the ketogenic diet was first introduced in 1921 as another method for treating seizures.

It had been noticed that starvation helped a lot of epilepsy patients in hospitals and it was then tried to combine the lack of carbohydrates caused by starvation with an intake of enough calories and protein combined. One could see that the ketogenic diet is more effective with a good ketosis, although no one is really sure why it works.

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